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Although possessing divine physicians like Lu Que and Bian Que, it would be difficult to exert their efforts. Zhang Sanxi said: Labor injury affecting the five zang organs can all lead to *Lao Zhai* (chronic consumptive disease), but only Lung Labor is incurable. This is because medicinal herbs are difficult to reach the lungs; methods of nourishing yin and clearing lung heat are hard to show efficacy in the lungs, and may instead damage the spleen and exacerbate the condition.

The yin essence of the human body is difficult to form yet easy to deplete. It is what is received from heaven (congenital endowment) and combined with grain qi (postnatal nutrition) to fill the body. However, medicines that tonify yin cannot produce effects overnight. Since jing-qi (essence and qi) has been weak for a long time, to warm the stomach qi and nourish the source of transformation, one must plan slowly. One should not use yang-assisting drugs, nor should one suppress yang. Assisting yang will inevitably lead to the loss of yin; suppressing yang requires pure yin formulas. Pure yin preparations are incompatible with stomach qi, and compounded by the austere and killing qi of autumn and winter. Yang-assisting drugs can temporarily support stomach qi, causing food intake to double. It appears as if spirit is strong and qi is prosperous, and no one would not rejoice. But over time, yang becomes more excessive and yin is scorched more. Therefore, how can assisting or suppressing yang be applied to those with yin deficiency? Ancient sages treating labor did not dare to overuse Ginseng (*Ren Shen*), precisely fearing that excessive yang would cause yin to diminish.

The *Jing Xue Pian* (Chapter on Essence and Blood) states: If a man engages in intercourse before his essence is full, draining his essence, there will be places in the five zang organs that are incomplete, and in the future, there will certainly be diseases that are difficult to describe. This is truly a profound statement. What are "formative yang" and "formless yang"? Formless yang refers to the ministerial fire of the Mingmen (Gate of Life). During the day, it moves and exerts its function on the Heart; at night, it rests and returns to store in the Kidney. It is the root of generating qi. Because it is formless and void, it is called "formless." Formative yang refers to the heart fire of the Sovereign (Emperor). Heart fire is the fire used in our daily postnatal life, but it is born from the Mingmen. Therefore, the Pericardium Meridian is connected to the Mingmen, and ministerial fire attaches to it. The Classics state: "Beside the seventh vertebra, there is a small heart," which refers to this. However, if heart fire were not born from the Mingmen, the *Nei Jing* (Inner Canon) would not say "benefit the source of fire to eliminate yin shadows." The meaning of "source" contains the logic of "mother." Thus, sovereign fire is a formative reality, which can be extinguished by water or dampened. Ministerial fire is a formless void, which cannot be extinguished by water or dampened directly. One must follow its nature and subdue it. From this perspective, the distinction between formless yang and formative yang is clear and obvious.

The Classics say: Diseases of the Two Yang (Stomach and Large Intestine) originate in the Heart and Spleen, manifesting as unspoken difficulties (emotional depression or sexual dysfunction), and in women, amenorrhea. If transmitted to become *Feng Xiao* (wasting away like wind-dried plants) or *Xi Ben* (accumulated breathing/asthma), it is a death case, untreatable. It says that diseases of the Two Yang originate in the Heart and Spleen. The reason the Heart and Spleen become diseased lies in the inability to express hidden emotions. The Heart governs blood, and the Spleen controls blood. Women's myriad diseases all arise from the Heart. If one worries, thinks, and depresses, keeping secrets that cannot be told, heart qi becomes knotted and heart fire blazes. Consequently, heart blood is depleted, and the functions of reception and discharge are exhausted. Moreover, since the mother causes the child to be deficient (Heart is the mother of Spleen in some contexts, or here implying mutual influence), the Spleen fails to transport and transform, leading to poor appetite. Poor appetite makes stomach qi even more deficient. The Lungs lose nourishment, so qi stagnates and does not move. Water essences cannot distribute to the four directions, failing to nourish kidney yin. The Kidney governs the two lower orifices. When Kidney deficiency occurs, the Large Intestine lacks endowment, and transmission and transformation fail. The Classics say: Food enters the Stomach, overflowing with essence and qi, which is transported up to the Spleen. The Spleen scatters essences, sending them up to return to the Lungs. The Large Intestine governs fluids (Jin), and the Small Intestine governs liquids (Ye). With insufficient maternal yin in the Kidney, heart fire becomes intense, injuring the Small Intestine organ. With the Spleen failing to scatter essences, Lung Metal lacks nourishment, causing the Large Intestine organ to dry up. This is what is meant by "diseases of the Two Yang originating in the Heart and Spleen." Generally, when qi from water and grain enters the Stomach, the clear part becomes Ying (Nutrient) blood, and the turbid part becomes Wei (Defensive) qi. The body's Ying blood fills and supports the body, relying entirely on abundant grain qi transforming into subtle essences to nourish the zang-fu organs. Since the Stomach receives little and the Large Intestine transports little, the fluids of both the Stomach and Large Intestine dry up. How can Ying blood then fill the meridians? This is why the pulses close and menstrual blood dries up, causing menstruation to not arrive on time. All things wither when encountering wind. *Feng Xiao* means muscles are completely wasted away, as if blown dry by wind. *Xi Ben* refers to lung yin exhaustion, where qi in the chest (Danzhong) is obstructed in breathing, causing breath to rush and asthma to occur. When the disease transmits to this stage, it is already critically dangerous. If not yet there, treatment can still be applied preventatively. Later sages said: Young men and unmarried women, harboring thoughts in their hearts, often suffer from labor injuries. In men, spirit and color scatter first; in women, menstrual water closes first. This is what is meant.

When yin and yang interact, Heaven and Earth are peaceful; when essence and qi combine, the human body is safe. The human body is a small heaven and earth. Above the philtrum, the eyes, nose, and ears have even-numbered apertures, corresponding to Kun (Earth) in the I Ching. Below the philtrum, the mouth and two lower orifices have odd-numbered apertures, corresponding to Qian (Heaven). Yin is above, Yang is below, thus preserving peace. Yin receives, Yang acts. If action exceeds reception, disease arises. Therefore, one must value moderating desires to preserve true innate energy. The characters for "Jing Qi" contain the radical for rice, indicating that jing and qi are all generated from rice. Thus it is said: Those who obtain grain prosper; those who lose grain perish. What humans rely on for life is jing qi, wei qi, and ying qi. Jing qi is produced from the Kidneys; Wei qi is produced from the Lungs; Ying qi is produced from the Liver and Heart. Although these three types of qi have different origins, when combined into one, they all take the Spleen and Stomach as their root. The Classics say: The Spleen is the solitary organ that irrigates the four sides; it also says: All five zang organs receive qi from the Stomach. Therefore, ancient people had the theory that "tonifying the Spleen is better than tonifying the Kidney."

Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) is a formula created by Zhang Zhongjing. A gentleman observes the Kan hexagram (☵) and understands the way of water and fire within the Kidneys. One yang line situated between two yin lines forms Kan. This is similar to human life and heaven and earth. Nowadays, people who engage excessively in intercourse and easily achieve erections have yin deficiency with fire moving. Those whose erections fail prematurely have declining fire in the Mingmen. When true water is exhausted, deep winter is not cold; when true fire ceases, midsummer is not hot. In this formula, Shu Di Huang (Prepared Rehmannia Root), Shan Zhu Yu (Cornus Fruit), Mu Dan Pi (Moutan Cortex), Ze Xie (Alisma Rhizome), Shan Yao (Dioscorea Rhizome), and Fu Ling (Poria) are all moistening and lubricating substances, used to strengthen the master of water (nourish kidney yin). Rou Gui (Cinnamon Bark) and Fu Zi (Aconite Root) are pungent and moistening substances, capable of supplementing fire within water, used to benefit the source of fire (warm kidney yang). When water and fire are nourished, kidney qi recovers its natural state. "Benefiting the source of fire to eliminate yin shadows" refers to this very formula. Benefiting the Spleen and Stomach to cultivate the mother of all things yields great benefits. The *Jing Yao* says: Long-term use will surely result in a robust physique and many children, demonstrating its efficacy in tonifying essence and blood. Zhang Zhongjing said: For qi deficiency with fire, use Shen Qi Wan to tonify and expel; he also said: Ba Wei Wan is the holy medicine for phlegm caused by water flooding. Zhu Danxi said: For prolonged illness with yin fire rising, where fluids generate phlegm instead of blood, one should use blood-tonifying drugs to control ministerial fire, and the phlegm will remove itself. Li Dongyuan (Yi Lao) said: Ba Wei Jiu treats pulse depletion and deficiency; it is a formula for the northwest regions. When metal is weak, water is excessive, and fire is deficient, or when the pulse is forceful upon pressing, it is also effective.

(Zhang) Commentary: Diseases arising in the human body invariably stem from yin-yang imbalance and water-fire excess. Especially for Lao Qie (consumptive weakness), which originates internally from the zang-fu organs and qi-blood, the practitioner must analyze yin-yang and water-fire meticulously, regulating them appropriately until balance is achieved. Then the disease will retreat without direct attack. Ba Wei Wan is indeed like the Eight Arrays of military strategy; its legislation is comprehensive and encompassing. Without yang, yin cannot generate; hence, Rou Gui and Fu Zi are included. Without yin, yang cannot generate; hence, Shu Di Huang and Shan Zhu Yu are included. Both congenital true yin and true yang are simultaneously tonified. Poria and Dioscorea are added to assist the Spleen and Stomach, ensuring the source of transformation has a basis, so that postnatal generation is endless. Moutan Cortex removes latent heat in the yin level; Alisma drains the evil fire and stagnant water of the Dragon and Thunder; together with Poria's mild diuresis, they transport the other herbs downward. One draining and one tonifying allows the tonification to be effective. If there is a sovereign herb without an envoy, it is difficult to act alone. The changes within are divine and illuminating, impossible to exhaust in words. For example, if the left Chi pulse is surging and rapid with severe yin insufficiency, add Shu Di Huang; if the right Chi pulse is faint and thin with severe yang insufficiency, add Rou Gui and Fu Zi; if the left Guan pulse is powerless with liver qi deficiency, add Shan Zhu Yu; if the right Guan pulse is powerless with spleen-stomach deficiency, add Fu Ling and Shan Yao; if stomach fire and bone-steaming fever are severe, add Mu Dan Pi; if yang excess and yin deficit are severe, reduce Rou Gui and Fu Zi; if stomach weakness and middle qi deficiency-cold are severe, remove Mu Dan Pi; if dryness and drought present with yang but no yin, remove Ze Xie; if lone yang floats upward and kidney qi cannot gather and accept, add Wu Wei Zi to assist the astringent power of Shan Zhu Yu; if yang deficiency and essence-blood depletion are severe, add Lu Rong (Deer Antler) and He Che (Placenta Hominis), sentient substances to aid the vigorous tonification of herbal materials; if kidney deficiency fails to grasp qi, with qi lingering in the upper jiao causing upper excess and lower deficiency, add Niu Xi to assist descent; if spleen-kidney deficiency-cold fails to steam, rot, close, and store, causing morning diarrhea, add Gu Pu Zhi (Psoralea Fruit) and Tu Si Zi (Cuscuta Seed) to simultaneously tonify spleen-kidney yang, serving as drugs for both congenital and postnatal sources. These are appropriate assistant and guiding herbs that can work together to achieve success. As for Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Xian Mao (Curculigo Rhizome), and Shou Wu (Polygonum Multiflorum Root), although powerful, their natures differ and categories vary. How can they compete for merit in a queue? Moreover, tonifying qi and blood differs from tonifying true yin and true yang. If mixed and added arbitrarily, each exerting its own force, disrupting the meridians and restraining each other, it will be of no benefit. As for Gou Qi (Goji Berry), Fu Pen Zi (Raspberry), and Lian Rou (Lotus Seed), their power is too slow. Adding one more ingredient slows it down further, making rapid effects difficult to achieve.

Ba Wei Wan can be taken with light salt water, taking advantage of salt's ability to moisten downward and soften hardness, guiding deficiency fire downward. It can be taken with rice soup, utilizing the bland true taste of the spleen-grain, which generates essence quickly, benefiting the spleen through kidney tonification. It can be taken with plain boiled water, neither fast nor slow, neither hot nor dry. It can be taken with warm wine, taking advantage of faster drug circulation, and warding off external cold in winter. It can be taken with decoction of Bu Zhong Yi Qi Tang, specifically for symptoms of yuan qi sinking. While wanting to secure the root, one also fears the drug acting too quickly downward, causing lower excess and upper deficiency. Thus, lifting the middle qi raises it, keeping the yuan qi of the three jiao constantly present. It can be taken with decoction of Li Zhong Tang, specifically for deep cold in the spleen and kidney. First regulating the central palace allows it to reach the lower jiao. It can be taken with decoction of Sheng Mai San, taking advantage of metal generating water, allowing mother and child to generate each other, with lung qi flowing into the kidney to become wei qi. Such decoction-wrapped pills are used because the disease is acute and cannot be delayed; both root and branch must be considered simultaneously. Thus, borrowing the sharp energy of the decoction to open the path, transporting the divine pill of water and fire to settle in the Dantian, preserving the permanence of yuan yang. The effect of the decoction is slight, while the nature of the pill re-emerges. From the root to the three jiao, harmonious yang is always present. The intention is profound. Moreover, although human diseases are numerous, none are more serious than Wind, Lao, Gu, and Ge syndromes. Long-term use of this drug solidifies true fire in the Dantian. How can deficiency wind rise suddenly? There is no need to worry about stroke. Sweet and warm can remove great heat; tonifying essence and blood facilitates generation. Bone-steaming latent heat has nowhere to reside. The formation of Lao syndrome becomes inherently unstable. With true fire filled below, yuan qi naturally grows in the middle. Transportation and transformation remain normal; how can abdominal distension exist? There is less worry about Gu syndrome. If there is a pot under the cauldron, the rice cooks itself; qi overflows and spreads, water essences distribute everywhere. How can dryness, obstruction, and dysphagia form? If major diseases can be eliminated, minor diseases are hardly entrenched. This is truly the highest realm of health preservation and the divine pill for establishing life. (Zhang) specially created this method of administration to supplement the未尽 (unfinished aspects) of the ancients.

Qian Yi removed Rou Gui and Fu Zi, naming it Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), to treat children, stating that children are purely yang. This formula primarily treats cases where kidney deficiency fails to control fire. The Kidney contains not only water but also the fire of the Mingmen. If the Kidney is not deficient, water is sufficient to control fire; if deficient, there is nothing to control it, and heat syndromes arise. This is named yin deficiency with fire movement, which Liu Hejian referred to as heat due to kidney deficiency. Nowadays, people with hot soles, hot inner thighs, and lower back pain all exhibit these symptoms, which are precursors to hemoptysis. Shu Di Huang and Shan Zhu Yu have rich flavors. The Classics say: Rich flavor belongs to yin within yin, thus it can tonify Shaoyin and nourish kidney water. Ze Xie is salty; salt enters the Kidney first. Rehmannia, Dioscorea, and Alisma are all moistening substances. The Kidney dislikes dryness and requires this moistening. The water tonified by this formula is formless water; the moistening substances are also formless, hence they are used. Mu Dan Pi is the root bark of the peony. Dan represents fire of the South. Being male and not female, it belongs to yang. Its flavor is bitter and pungent, thus it enters the Kidney to astringe yin fire, benefiting Shaoyin and calming deficiency heat. Fu Ling is sweet and bland. Sweet transforms via Earth; Earth can control water, and bland can drain and seep. Thus, it is used to control pathogens in the water organ. Shu Di is warm and Mu Dan Pi is cool; Shan Yao is astringent and Fu Ling is draining; Shan Zhu Yu is gathering and Ze Xie is draining. It tonifies the Stomach and simultaneously the Spleen. Having tonification accompanied by draining, they harmonize and assist each other to achieve balanced tonification. It is the miracle of blandness, hence regarded as an excellent prescription unchanging through ancient and modern times. It benefits the Spleen and Stomach to cultivate the mother of all things, strengthens the master of water to calm solar flare, referring to this medicine. Adding Wu Wei Zi to Liu Wei creates Du Qi Wan, reflecting the meaning of describing categories and imitating forms.

"Nourishing yin to descend fire" means that by nourishing yin, fire descends naturally. One should understand this holistically rather than focusing solely on descending fire. The two Chi pulses each contain descending yin, water, and fire, mutually generating and transforming. One must differentiate yin-yang and deficiency-excess within these two organs and seek their belonging to balance them. If the person's pulse is weak, fine, and rapid, it indicates insufficiency of true yin in the left Kidney. Use Liu Wei Wan. If the right Chi pulse is slow and soft, or deep, fine, and nearly absent, it indicates insufficiency of ministerial fire in the Mingmen. Use Ba Wei Wan. If both Chi pulses are weak and minute, it indicates simultaneous deficiency of yin and yang. Use Shi Bu Wan. All these nourish the congenital kidney source, offering infinite benefits for generations. Since then, those tonifying yin mostly use Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome), which instead damage the spleen and stomach, often leading to untreatable conditions, leaving harmful legacies for the world.

Heat sickness with thirst, drinking cold fluids, and constipation belong to excess heat. Aversion to cold, fever, pulling clothes to curl up, belong to reverse cold. Clear and loose stools belong to true cold. Everyone knows this. As for restlessness, madness, aversion to clothing, desire to sit or lie in mud and water, these belong to false heat syndromes. Severe cases involve extreme restlessness, incessant thirst, tongue like thorns, dry and cracked cheeks, face painted red, body burning like fire, soles of feet like iron, vomiting phlegm like a surge, rapid breathing and coughing, severe constipation, scanty urination, and six pulses surging without measure. They resemble Cheng Qi Tang or Bai Hu Tang syndromes. However, Cheng Qi Tang and Bai Hu Tang would kill upon ingestion. This is extreme kidney yin deficiency, with yang having no attachment, floating and scattering externally. It is not real fire. One should urgently prepare one jin (approx. 500g) of modified Ba Wei Wan material, add one liang (approx. 30g) of Rou Gui, decoct rapidly in water, make five to six bowls, and drink cold. Various symptoms will recede. The next day, there will definitely be aversion to cold and pulse disappearance, revealing the true pattern. One must vigorously tonify yang. Urgently decoct and administer Fu Zi Ba Wei Wan material for self-healing. This syndrome and pulse deviate from the norm and cannot be treated with standard methods.

If there is postpartum hemorrhage or massive blood loss, sudden injury to yin-blood causes high fever, also named yin-deficiency fever. The character "yin" here refers to the yin of qi and blood. If treated with cooling drugs as a standard cure, death is immediate. It resembles Bai Hu Tang syndrome; misusing Bai Hu Tang leads to death. Although yin qi is greatly deficient, Si Wu Tang is not used. Formative blood cannot be generated quickly; the slightest amount of qi must be urgently secured. One must use Du Shen Tang (Single Ginseng Decoction) etc., to allow the formless to generate the formative. This is the wonderful application of yang generating yin. However, both qi deficiency and blood deficiency are internal injuries. How to distinguish them? Yin deficiency manifests with a red face, as formless fire crowns the upper body. If it is a yang syndrome, fire enters inward, and the face will not be red. Thirst is severe because kidney water is dried up, drawing water to save itself. Although thirsty, the tongue must be slippery. Although the pulse is rapid, the Chi position must be powerless. In severe cases, even if the Chi pulse is surging and rapid, pressing it reveals no rebound force. This is the differentiation. Although, if the person has previously taken cooling drugs, the pulse will counter-intuitively become forceful and rebounding, forcing yang outward, creating a false sense of strength. Dai Fu'an said: If the pulse becomes more rapid after taking cooling drugs, it is fire depression. Directly tonifying is appropriate; cold and cooling must be strictly avoided. Violating this leads to death. A difference of a hair's breadth costs lives. Be cautious!

For kidney deficiency with fire not returning to its vessel, presenting with high fever, irritability, thirst, red eyes, cracked lips, prickles on the tongue, throat feeling like smoke and fire, soles of feet like iron, surging and boundless pulse, weak upon pressure, use Shi Quan Da Bu Tang (Ten-Agent Great Tonifying Decoction) to swallow Ba Wei Wan. Someone asked: With such dryness and heat, how can you administer Gui and Fu again? Isn't this adding fire to fire? I reply: The pericardium ministerial fire attaches to the Mingmen. Men store essence with it; women connect the uterus with it. Due to excessive desires exhausting the fire, it has no attachment, thus rebels and flares upward. Moreover, fire emerges from the Kidney; it is fire within water. Fire can be broken by water, but fire within water cannot be broken by water. The fire of Gui and Fu shares the same qi and has a pungent flavor. It opens the interstices, promotes fluid secretion, and unblocks qi pathways. Occupying its lair, it attracts fire through similarity of qi, causing the fire to descend. Thus, Gui and Fu are indeed the correct medicines for treating fire.

Kan represents dry water, qi. It is small like a well, large like the sea. Dui represents kun water, form. It is slight like dew, large like rain. One yang trapped in two yins forms Kan. Kan is water qi,潜行 (hidden flow) underground, the fundamental root receiving destiny for all things. Hence it is said: Moistening all things, nothing moisters like water. One yin penetrating two yangs forms Dui. Dui uses formative water to generously bestow upon all things above, providing the benefit of life. Hence it is said: Delighting all things, nothing delights like marsh. Understanding this one water allows one to comprehend the way of treating fire. Heart fire is formative fire. Ministerial fire is formless fire. Formless fire causes internal dryness and heat and fluid exhaustion. Using formative Dui water of the Five Elements to control it is a temporary expedient. Our body possesses true water qi from Shangchi (Upper Pool). It is formless. Using formless water to irrigate formless fire is constant and enduring. This is true water and true fire; when ascending and descending are appropriate, we achieve Ji Ji (Completion). Physicians who do not comprehend the true substance of congenital Taiji, nor exhaust the wonderful applications of formless fire and water, and thus cannot use the divine agents of Liu Wei and Ba Wei, lack more than half of medical principles. This discussion by Zhao (Shu) deeply grasps the origin of water and fire and obtains the unchanging treatment methods for water and fire.

(Zhang) Commentary: The onset of hundred diseases stems from fire; the emergence of fire stems from yin deficiency; the root of deficiency stems from the Kidney. Water is the origin of all things; fire is the father of all things. Their origin and father are rooted in the Kidney. Whenever kidney yuan is sufficient, all phenomena are peaceful, and diseases cease. Thus, there are Heart diseases involving the Kidney, Spleen diseases involving the Kidney, Liver diseases involving the Kidney, and Lung diseases involving the Kidney. Diseases of the four zang organs do not escape the Kidney. Furthermore, what humans rely on for life is entirely dependent on the function of yin-yang and water-fire, and the Kidney is the total root of yin-yang and water-fire. If yin-yang is imbalanced and water-fire is excessive, hundred diseases arise. In treatment, saving yin involves strengthening water; tonifying yang involves benefiting fire. However, the Kidney is a water organ and also a fire organ. Therefore, those saving yin and tonifying yang, if they do not seek the master of water and the source of fire, abandoning the water-fire organs and rejecting Liu Wei and Ba Wei, how can they find the door to enter? It is like a tree planter wanting to abandon the roots and expecting growth! Only when the spleen and stomach suddenly become deficient and cold does warming and tonifying treat from the center, employing Bu Zhong and Li Zhong methods. Over time, responsibility shifts to the Kidney, employing Ba Wei plus Gu Pu Zhi and Wu Wei Zi. The rest, whether internal or external, eye and tooth issues, obstetrics and gynecology, and myriad diseases in men and women, especially those belonging to yin/yang deficiency and false yin/false yang syndromes, all revere this as a holy medicine.